Provider Demographics
NPI:1750458816
Name:SLEEP, SUSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:SLEEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 KATELLA AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2445
Mailing Address - Country:US
Mailing Address - Phone:562-936-0292
Mailing Address - Fax:562-936-1943
Practice Address - Street 1:3742 KATELLA AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2445
Practice Address - Country:US
Practice Address - Phone:562-936-0292
Practice Address - Fax:562-936-1943
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG066731207R00000X
CAG66731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78316Medicare UPIN